Do Psychological Factors Affect Teatment Outcome in TMDs

There has been considerable controversy over the years regarding the importance of psychological factors in the diagnosis, etiology, progression and response to treatment in the field of temporomandibular disorders (TMDs). Few studies have looked carefully at the influence of psychological factors on different components of TMDs. For example, on disorders primarily involving the TM joint versus those involving primarily the muscles and soft tissues. The study described below offers some interesting insight into this question.

"TMD Treatment Outcomes: A Statistical Assessment of the Effects of Psychological Variables"

Dr. Pamela Steed, DDS, MSD

Jour of Craniomandib Practice, (16)3: 138-42, 1998

This study analyzes the degree to which pretreatment psychosocial factors (psychological dysfunctions and stress) effect outcome in 269 consecutive temporomandibular disorder (TMD) patients at the completion of treatment. Employing the TMJ Scale, a validated measure of TMD symptoms, it is found that pretreatment TMD pain and overall symptom levels (excluding internal derangement symptoms) are weakly but nevertheless, significantly related to pretreatment psychological dysfunction and stress. However, the latter appeared totally unrelated to four treatmentoutcome measures. Additionally, the data supports the hypothesis that both initial and post-treatment intrascapular symptoms (TMJ Scale, Joint Dysfunction sub-scale) are unrelated to psychosocial factors. Data from this study call into question the value of categorizing the TMD patients by means of psychosocial "profiling" and "dual-axis" classification methods proposed by some researchers.

Hello, my name is Steve Levitt and welcome to my Blog. I'm a physician with 34 years of experience treating patients and conducting research on temporomandibular disorders (sometimes called "TMD" or "TMJ") and chronic pain. Prior to my MD, my PhD research involved the study of the inorganic component of teeth and bones. I was an NIH Research Fellow during medical school at Case Western Reserve Univ, and did my Psychiatry Residency at University of North Carolina in Chapel Hill. In 1979 I joined the Clinical Faculty, Dept. of Psychiatry at the U.N.C. School of Medicine. As Adjunct Associate Professor for 18 years I was Psychiatric Consultant to the dentists and physicians of the U.N.C. Clinical Pain Program. In 1982 I co-founded Pain Resource Center, Inc., a company devoted to developing clincial evaluation tools in the field of chronic pain and TM disorders. I directed research programs which led to development of the "TMJ Scale" used by dentists and TMJ Specialists to screen for and measure the symptoms of temporomandibular disorders, and the 'Chronic Pain Battery' for chronic pain evaluation and treatment.